Availability of on-site catheterization and clinical outcomes in patients receiving fibrinolysis for ST-elevation myocardial infarction

J. Llevadot, Robert P. Giugliano, E. M. Antman, R. G. Wilcox, E. P. Gurfinkel, T. Henry, C. H. McCabe, A. Charlesworth, S. Thompson, J. C. Nicolau, U. Tebbe, Z. Sadowski, E. Braunwald

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Aims: To compare management and clinical outcomes in hospitals stratified by the availability of on-site catheterization in InTIME-II, a multicentre trial comparing alteplase with lanoteplase for acute myocardial infarction. Methods and Results: We studied 15 078 patients enrolled in 35 countries and 855 hospitals. Thirty-one percent of hospitals had 24-h, 25% day-only, and 44% no on-site catheterization facilities. Rates of cardiac angiography (57%, 38%, 26%) and revascularization (37%, 21%, 17%) were higher in hospitals with increasing access to on-site facilities (P<0.0001). The presence of a 24-h on-site facility was the strongest predictor of angiography during the index admission (odds ratio 4.17, 95% CI 3.85-4.54). There were no major differences in patient outcomes at 30 days when hospitals were stratified by availability of on-site catheterization. Adjusted 1-year mortality was similar between groups of hospitals (odds ratio for day-only 0.94 [0.80-1.09] and odds ratio for no availability 0.95 [0.83-1.10] compared to hospitals with 24-h facilities). Conclusions: There is a marked variation in procedure use by the availability of on-site catheterization with no major differences in patient outcomes. There is a need for additional randomized trials in the current era to address both the appropriate selection of patients and timing of invasive procedures in ST-elevation acute myocardial infarction.

Original languageEnglish (US)
Pages (from-to)2104-2115
Number of pages12
JournalEuropean heart journal
Volume22
Issue number22
DOIs
StatePublished - 2001

Keywords

  • Availability of on-site catheterization
  • Fibrinolysis
  • Myocardial infarction
  • Outcomes

Fingerprint Dive into the research topics of 'Availability of on-site catheterization and clinical outcomes in patients receiving fibrinolysis for ST-elevation myocardial infarction'. Together they form a unique fingerprint.

Cite this